Lateral Cervical Approach for Superior Mediastinal Lymph Node Dissection in Thyroid Cancer: A Novel Surgical Technique

Objective Although various surgical approaches exist for superior mediastinal lymph node dissection in thyroid cancer, each technique has significant limitations. We present a novel surgical approach via the lateral cervical route that provides an alternative for thyroid cancer patients requiring this procedure. Methods We conducted a retrospective analysis on patients who underwent superior mediastinal lymph node dissection (SMLND) via the lateral cervical approach at an academic tertiary care center between March 2023 and December 2024. Surgical safety, efficacy, and short-term outcomes were evaluated. Results Our cohort consisted of 21 patients who successfully underwent superior mediastinal lymph node dissection via the lateral cervical approach without severe intraoperative complications. The mean operative time was 153.14 ± 37.52 minutes, and the average intraoperative blood loss was 54.05 ± 18.84mL. No in-hospital deaths or uncontrollable intraoperative hemorrhages were observed. The mean postoperative hospital stay was 5.67 ± 0.91 days. Postoperative complications included chylous leakage in 3 cases and hoarseness in 2 cases. All patients achieved R0 or R1 resection; however, the average number of superior mediastinal lymph nodes dissected was 7.86 ± 3.12. Follow-up at 3–6 months revealed no abnormal elevation of thyroglobulin levels or imaging evidence of recurrent lymphadenopathy. Conclusion Our results suggest that this novel lateral cervical approach for SMLND is both safe and effective, addressing several limitations of previous techniques. It offers a valuable surgical option for superior mediastinal lymph node dissection in thyroid cancer, particularly for metastases in the 2R and 2L regions.